Diel R, Nienhaus A, Lampenius N, Rüsch-Gerdes S, Richter E
Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.
Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Respir Med. 2014 Nov;108(11):1677-87. doi: 10.1016/j.rmed.2014.09.021. Epub 2014 Oct 15.
4220 new cases of tuberculosis (TB) were reported in Germany in 2012; of those, 65 cases were multidrug-resistant TB (MDR-TB) or extensively multidrug-resistant TB (XDR-TB) cases. However, there is only limited information on the economic consequences of drug resistance patterns on the treatment costs of MDR-and XDR-TB patients.
On the basis of drug susceptibility of the single MDR-TB/XDR-TB strains the direct medical costs of suitable therapies were calculated according to the current guidelines of the World Health Organization (WHO) and those of the German Central Committee against Tuberculosis. These costs were combined with hospital and outpatients monitoring costs and followed the most recent German invoicing system and health statistics. Total drug and monitoring costs and were determined by Monte-Carlo simulation comprising all different options.
According to this, the mean drug costs were €51,113.22 (range €19,586.14 to €94,767.90). The weighted costs for hospitalization were €26,000.76 per patient compared to only €2,192.13 for primary outpatients; the total treatment costs of MDR-TB amounted to €64,429.23. These are joined by the costs due to loss of productivity, varying between €17,721.60 and €44,304. From a societal perspective, the total cost per MDR-TB/XDR-TB case reach an amount between €82,150 and €108,733 per case, respectively.
Cost analyses based on strain resistance patterns allow more reliable estimates of the real costs of treating MDR-TB/XDR-TB than do methods that ignore this factor. Advantageously, they demonstrate the economic impact of drug-resistant TB in low-incidence countries. Costs of productivity loss is of new importance because of the length of MDR-XDR therapy, but its true share of total costs has still to be determined.
2012年德国报告了4220例新发结核病病例；其中，65例为耐多药结核病（MDR-TB）或广泛耐药结核病（XDR-TB）病例。然而，关于耐药模式对MDR-TB和XDR-TB患者治疗费用的经济影响的信息有限。
根据单个MDR-TB/XDR-TB菌株的药敏情况，按照世界卫生组织（WHO）和德国结核病中央委员会的现行指南计算合适治疗方法的直接医疗费用。这些费用与医院和门诊监测费用相结合，并遵循德国最新的计费系统和健康统计数据。通过包含所有不同选项的蒙特卡洛模拟确定总药物和监测费用。
据此，平均药物费用为51,113.22欧元（范围为19,586.14欧元至94,767.90欧元）。每位患者的住院加权费用为26,000.76欧元，而初级门诊患者仅为2,192.13欧元；MDR-TB的总治疗费用为64,429.23欧元。此外还有因生产力损失产生的费用，在17,721.60欧元至44,304欧元之间。从社会角度来看，每例MDR-TB/XDR-TB病例的总成本分别达到82,150欧元至108,733欧元。
基于菌株耐药模式的成本分析比忽略该因素的方法能更可靠地估计治疗MDR-TB/XDR-TB的实际成本。有利的是，它们展示了耐药结核病在低发病率国家的经济影响。由于MDR-XDR治疗时间长，生产力损失成本具有新的重要性，但其在总成本中的实际占比仍有待确定。
